HERNIAS • SENIOR RESIDENT / SURGEON

Incarcerated Groin Hernia

A painful irreducible groin mass with bowel obstruction forces the surgeon to distinguish incarceration from strangulation and decide when reduction is unsafe.

PROTOTYPE REVIEW REQUIRED

The Call

57-year-old man with a known right inguinal hernia

Four hours of sudden nausea, vomiting and obstipation with a hard tender irreducible right groin mass. CT shows small bowel obstruction with the transition point within the groin hernia.

T 37.9 C • HR 110 • BP 116/72

The key question is not merely whether the hernia is incarcerated; it is whether strangulation or ischemia is already present.

Read the Image • Clinical DataACS VISUAL

Incarcerated groin hernia image from the ACS image archive.

Make the Decision • Commit to a Plan

Incarcerated Groin Hernia

57-year-old man with a known right inguinal hernia

A painful irreducible groin hernia is associated with SBO, leukocytosis, metabolic acidosis and overlying erythema. Best next step?

The incarcerated small bowel reduces spontaneously during induction. What should you do?

After repair the patient develops worsening abdominal pain, lactate 5 and tachycardia despite a benign groin incision. Best next step?

Open the sac, control the anatomy, and inspect the bowel before it disappears from view.

The postoperative course reflects both the hernia repair and the bowel insult.

Surgical Pearls

Pitfalls

The hernia spontaneously reduces after induction of anesthesia, but preoperative findings strongly suggested strangulation. What must still be addressed?